Aromatase inhibitors for the treatment of breast cancer: is tamoxifen of historical interest only?

摘要: Breast cancer is the second most common cause of death from malignancy in American women ( 1 ) . Although it almost uniformly fatal, metastatic breast very treatable, and many patients will live for long periods time with good quality life 2 In this regard, nearly 100 000 are living United States 3 There reason to be optimistic that expectancy extended further as novel therapies targeting growth pathways, cell signaling, tumor microenvironment developed. Among these therapies, oldest effective those target estrogen receptor pathway. importance endocrine control was recognized by Beatson 110 years ago 4 , fi eld still exploring means optimizing therapy. Over last 35 years, selective modulator tamoxifen has become standard care hormone – positive western world 5 However, several recent studies have suggested depletion may a slightly more strategy against hormone-dependent cancer. postmenopausal patients, best accomplished specifi c inhibition aromatase, which converts precursors, dihydroepiandrostenedione testosterone, respectively, estradiol estrone. These aromatase inhibitors were developed after recognition aminoglutethimide, nonselectively inhibits number critical enzymes steroidogenesis, including cytochrome P450 CYP19, controlling Subsequent translational demonstrated agents cally equally or than aminogluthamide, yet safer 6 Aromatase now widely used treating both adjuvant setting, ongoing investigating use prevent 7 issue Journal Mauri et al. 8 report metaanalysis published randomized controlled trials comparing therapy Overall, they conclude either rst- second-line inhibitor results moderate, but statistically signifi cant, proportional prolongation overall survival approximately 10%. When compared nonaromatase treatments cancer, effect predicts an increased months among expected median 40 months.